Marketing Group PresentationMarketing Group Presentation

Cost Analysis by Anawat Pinisakul Intellectual Property Laws in Thailand by Phanit Ratasuk Health Insurance in Thailand by Chate Jaikunya FDA Thai by Manaswee Arayasiri Southeast Asia Market by Myat Htay Kyi HIV in China by Wang Xiaofeng

Cost and Financing Aspects of Cost and Financing Aspects of Providing Anti-Retroviral TherapyProviding Anti-Retroviral Therapy

Marketing Group of AIDS DrugMarketing Group of AIDS Drug

ByBy

Mr. Anawat PinisakulMr. Anawat Pinisakul EVD998498EVD998498

AdvisorAdvisor

Dr. Maria KartalouDr. Maria Kartalou

Dr. Suvit LoprasertDr. Suvit Loprasert

Today PresentationToday Presentation

Introduction• Background

• Treatment of AIDS by drug

Contents• Cost and financing aspect

• Cost-saving and cost-effectiveness

Conclusions

IntroductionIntroduction

The HIV/AIDS was first recognized in the The HIV/AIDS was first recognized in the early 1980s.early 1980s.

Treatment options were limited.Treatment options were limited. AZT drug (Zidovudine) was approved by AZT drug (Zidovudine) was approved by

USA’s FDA in 1987.USA’s FDA in 1987. This drug is now widely used in North This drug is now widely used in North

America, Europe and AustraliaAmerica, Europe and Australia Other anti-retrovirals (ARVs)Other anti-retrovirals (ARVs)

IntroductionIntroduction

In contrast, ARVs are not yet widely available in In contrast, ARVs are not yet widely available in developing countries.developing countries.• AsiaAsia• AfricaAfrica• Latin AmericaLatin America

ARVs combination therapiesARVs combination therapies• Prolong lifeProlong life• Prevent HIV-infected progressionPrevent HIV-infected progression• Reduce transmission of HIV from mother to childrenReduce transmission of HIV from mother to children

ContentsContents

Cost of providing anti-retroviral therapy Total cost implication of providing anti-retroviral

therapy Total cost implications of providing anti-retroviral

therapy in comparison with available resources Cost-saving potential and cost-effectiveness of

anti-retroviral therapy Financing anti-retroviral therapy

Cost of providing anti-retroviral Cost of providing anti-retroviral therapytherapy

Three types of drugThree types of drug• Nucleoside reverse transciptase inhibitorsNucleoside reverse transciptase inhibitors

• Protease inhibitorsProtease inhibitors

• Non- Nucleoside reverse transciptase inhibitorsNon- Nucleoside reverse transciptase inhibitors

Drug Unit Cost ($) Monthly Cost ($)Annual Cost ($)

1. zidovudine (AZT) 1.50 per 100 mg 228 2,738

2. didanosine (DDI) 1.44 per 100 mg 175 2,102

3. zalcitabine (DDC) 2.4 per 0.75 mg 220 2,640

4. stavudine (D4T) 3.9 per 40 mg 232 2,788

5. lamivudine (3TC) 3.6 per 150 mg 214 2,572

6. ritonavir 11.5 per 600 mg 692 8,308

7. saquinavir 6.1 per 600 mg 545 6,540

8. idinavir 4.4 per 800 mg 533 6,400

9. nevirapine 4.12 per 100 mg 272 3,260

Double combination therapies See above 403-773 4,836-9,276

- 1 + 2 or 3 or 4 or 5

- 5 + 4

- 3 + 7

- 4 + 2

Triple combination therapies See above 662-993 7,944-11,916

- 1 + 3 + 7

- 1 + 3 + 5

- 1 + 2 + 9

- 1 + 2 + 8

}

Cost of providing anti-retroviral Cost of providing anti-retroviral therapytherapy

Drug and dosage require Unit Cost ($)Monthly Cost ($)Annual Cost ($)

6. ritonavir 11.5 per 692 8,308

600 mg twice daily 600 mg

7. saquinavir 6.1 per 545 6,540

600 mg three times a day 600 mg

8. idinavir 4.4 per 533 6,400

800 mg every 8 hours 800 mg

Estimated Number of People

Total cost implication of providing anti-Total cost implication of providing anti-retroviral therapyretroviral therapy

112,000

6,0004,0002,00019,000

803,000

61,000

2,00052,00091,000

6,378,000

169,00065,00030,000343,000976,000

23,000642,000

837,000

10,809,000

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

Graphic Region

Est

ima

ted

Nu

mb

er

Estimated Number of People with HIV infection butnot AIDS in 1996Estimated Number of People with AIDS in 1996

North America Oceania

Latin America

Sub-Saharan Africa

Caribbean

Eastern Europe

SE Mediterranean

Northeast Asia

Southeast AsiaWestern EuropeGeographic Region

Total cost implication of providing anti-Total cost implication of providing anti-retroviral therapyretroviral therapy

Estimated Cost ($billion)

0

50

100

150

200

250

300

Geographic Region

Triple combination therapy if 100% of those eligible receive it

AZT therapy if 100% of those eligible receive it

Triple combination therapy if 50% of those eligible receive it

AZT therapy if 50% of those eligible receive it

North America

Western Europe

Oceania

Latin America

Sub-Saharan Africa

Caribbean

Eastern Europe

SE Mediterranean

Northeast Asia

Southeast Asia

Total cost implications of providing anti-Total cost implications of providing anti-retroviral therapy in comparison with retroviral therapy in comparison with available resourcesavailable resources

Geogrphic Region Estimated Annual Estimated Annual Cost of ARV Estimated Annual Cost ofCost of ARV Therapy Therapy as % 1990 Total Health ARV Therapy as %as % 1991 GDP Expenditures National AIDS Budgets

North America 0.2 1.8 243Western Europe 0.1 1.9 8,727Oceania 0.1 1.3 500Latin America 1 23.9 720Sub-Saharan Africa 66.9 1,673 2,017,500Caribbean 14.8 370 714,286Eastern Europe 0.04 1 5,000SE Mediterranean 0.1 3.5 20,000Northeast Asia 0.06 1.5 2,400Southeast Asia 14.6 364 128,857

Total cost implications of providing anti-Total cost implications of providing anti-retroviral therapy in comparison with retroviral therapy in comparison with available resourcesavailable resources

Number of patientsNumber of patients Cost of treatmentCost of treatment

• GDPGDP

• Health expendituresHealth expenditures

Cost-saving potential and cost-Cost-saving potential and cost-effectiveness of anti-retroviral therapyeffectiveness of anti-retroviral therapy

Cost-saving potentialCost-saving potential• AZT therapyAZT therapy

– Reduced health care costs in comparison with not receive drugReduced health care costs in comparison with not receive drug

• Triple-combination therapiesTriple-combination therapies– Cost save in 4.6 times per capita incomeCost save in 4.6 times per capita income

Cost-effectivenessCost-effectiveness• AZT therapyAZT therapy

– Prolong lifeProlong life

• Triple-combination therapiesTriple-combination therapies– Reduce medical costsReduce medical costs

Financing anti-retroviral therapyFinancing anti-retroviral therapy

High cost with ARV therapyHigh cost with ARV therapy• Financing care may not be sufficientFinancing care may not be sufficient

Health care financingHealth care financing• TaxationTaxation

• Social insurance systemSocial insurance system

• Private insurancePrivate insurance

• User feesUser fees

• Community financing schemesCommunity financing schemes

Financing anti-retroviral therapyFinancing anti-retroviral therapy

Private insurance companiesPrivate insurance companies• Difficult for patient to receive helpingDifficult for patient to receive helping

• Employers in the USA try to exclude AIDS Employers in the USA try to exclude AIDS patients from group insurance policespatients from group insurance polices

Public sectorPublic sector• In Maryland, MedicaidIn Maryland, Medicaid

• 65% of AIDS patients65% of AIDS patients

ConclusionsConclusions

ARV therapy does appear affordable and cost-ARV therapy does appear affordable and cost-effective in high-income countrieseffective in high-income countries

ConsiderationConsideration• Number of HIV patientsNumber of HIV patients

• Income of populationIncome of population

• Type of drugType of drug

• Government sectionGovernment section

Thank You!Thank You!

Dr. Maria KartalouDr. Maria Kartalou Dr. Suvit LoprasertDr. Suvit Loprasert MIT StaffMIT Staff CRI StaffCRI Staff Our ClassesOur Classes

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